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Postpartum psychosis is an uncommon but serious psychiatric emergency that can develop after childbirth, and recognizing its warning signs early is critical to getting new mothers the care and support they need.
Uruj Kamal Haider, MD, assistant professor of psychiatry & behavioral sciences and obstetrics & gynecology, a perinatal psychiatrist and medical director of the Massachusetts Child Psychiatry Access Program for Moms at UMass Chan Medical School, has recently discussed postpartum psychosis with WBUR’s Here & Now, CBS News’ Healthful with Norah O’Donnell, CBS Boston, The Boston Globe and The Washington Post. In a TIME op-ed, Dr. Haider also called attention to the need for greater awareness, earlier recognition and better support for new mothers and their families.
Here, Haider answers frequently asked questions, including what families should watch for and what remains unknown about the condition.
What is postpartum psychosis, and how is it different from postpartum depression and the “baby blues”?
Postpartum psychosis is an uncommon, potentially lethal but highly treatable medical illness characterized by symptoms such as delusions, hallucinations, disorganization and confusion. It occurs in about 1 to 2 in 1,000 people after childbirth.
Postpartum psychosis often occurs in the context of a mood disorder, particularly bipolar disorder. About 70 percent of cases occur in the context of bipolar disorder, Haider said.
Postpartum depression is much more common and typically involves persistent sadness, hopelessness, helplessness or thoughts of death. The “baby blues” are even more common and generally involve temporary mood changes after childbirth.
What are the early warning signs, or “pink flags,” of postpartum psychosis?
There is a spectrum of psychotic symptoms, and the earliest signs can be subtle. Haider calls these “pink flags;” quieter warning signs that can appear before more obvious psychosis.
Pink flags may include irritability, mood changes, disorganized thinking, disorientation and rapid speech. A person does not need to experience hallucinations to be experiencing psychosis, Haider said.
When pink flags progress to “red flags,” such as florid psychosis, it is a psychiatric emergency and the mother should be safely taken to an emergency department.
Haider discussed the importance of recognizing these early signs in her CBS News Healthful interview and with The Washington Post.
Can someone have postpartum psychosis and still appear to be functioning normally?
Yes. One important feature of postpartum psychosis is that symptoms can wax and wane. Someone may appear coherent and seem like themselves at one moment and become confused or disorganized hours later, Haider said.
The illness can also deteriorate rapidly, particularly in the setting of recent childbirth and severe sleep deprivation. That is why subtle changes should be taken seriously.
Who is at risk for postpartum psychosis?
Bipolar disorder is the strongest known risk factor, but postpartum psychosis can occur unexpectedly. About half of people who develop it have no previous psychiatric history, Haider said.
Other risk factors include stopping psychiatric medications during pregnancy, a personal or family history of postpartum psychosis, and a family history of bipolar disorder.
When does postpartum psychosis usually begin?
Postpartum psychosis most often begins within the first few days to weeks after childbirth, although it can occur later in the postpartum period, including several weeks or, less commonly, several months after childbirth.
What causes postpartum psychosis?
There is no single known cause. Haider said researchers believe several factors may contribute, including genetic vulnerability, rapid hormonal changes after childbirth, sleep deprivation and underlying psychiatric risk factors.
What remains unclear is why childbirth appears to trigger psychosis in some people but not others, including people with no previous psychiatric history.
What should family members or healthcare providers do if they notice signs?
Anyone in a new mother’s “village,” including a partner, family member, neighbor, grandparent, obstetrician, doula or pediatrician, can play an important role in recognizing warning signs. In her TIME op-ed, Haider emphasized that these people with close ties to the mother are often among the first to notice that something is wrong and need plain-language guidance about what early psychosis can look like.
If there is a concern for psychosis, suicide or homicide, Haider advises bringing the mother to the emergency room immediately, while ensuring the baby is cared for in a safe environment.
How is postpartum psychosis treated, and can someone recover?
Postpartum psychosis is temporary and highly treatable. Treatment generally involves psychiatric hospitalization and may include antipsychotic medication, a mood stabilizer and a benzodiazepine, Haider said.
The most important step is getting the mother safely to a hospital for an immediate psychiatric evaluation. With prompt and appropriate treatment, postpartum psychosis can be successfully treated.
